No abstract

MONG PERSONS DIAGNOSED AS having diabetes mellitus, the lifetime risk of developing a foot ulcer is estimated to be 15%. 1 Based on recent studies, the annual population-based incidence ranges from 1.0% to 4.1% 2 and the prevalence ranges from 4% to 10%, which suggests that the lifetime incidence may be as high as 25%. 3,4 Lower extremity disease, including peripheral arterial disease, peripheral neuropathy, foot ulceration, or lower extremity amputation, is twice as common in diabetic persons compared with nondiabetic persons and it affects 30% of diabetic persons who are older than 40 years. 5 Foot ulcers cause substantial emotional, physical, productivity, and financial losses. 6-9 The estimated costs of treating a diabetic foot ulcer were $28 000 in a 1999 US study, 10 and $18 000 (with no amputation) and $34000 (with amputation) in a 2000 Swedish study. 11 The most costly and feared consequence of a foot ulcer is limb amputation, which occurs 10 to 30 times more often in diabetic persons than in the general population. 12,13 Diabetes underlies up to 8 of 10 nontraumatic amputations, of which 85% follow a foot ulcer. 1 , 3 , 1 4 The age-adjusted annual incidence for nontraumatic lower limb amputations in diabetic persons ranges from 2.1 to 13.7 per 1000 persons. 2 Mortality following amputation ranges from 13% to 40% at 1 year, 35% to 65% at 3 years, and 39% to 80% at 5 years-worse than for most malignancies. 2 In light of the enormous disease burden of diabetic foot ulcers, it is crucial See also Patient Page.

Healthcare-associated infections due to multidrug-resistant Gram-negative bacteria (MDR-GNB) are a leading cause of morbidity and mortality worldwide. These evidence-based guidelines have been produced after a systematic review of published studies on infection prevention and control interventions aimed at reducing the transmission of MDR-GNB. The recommendations are stratified by type of infection prevention and control intervention and species of MDR-GNB and are presented in the form of 'basic' practices, recommended for all acute care facilities, and 'additional special approaches' to be considered when there is still clinical and/or epidemiological and/or molecular evidence of ongoing transmission, despite the application of the basic measures. The level of evidence for and strength of each recommendation, were defined according to the GRADE approach.